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My Family Medicine Story

Hal L. Grotke, MD, FAAFP


I was four years old when I first told my mother that I would be a doctor when I grow up. Although I got sidetracked along the way, eventually I realized that dream. I had grown up with a strong sense of social justice, so family medicine seemed like a natural fit. I worked at community health centers and eventually came to be the owner and medical director of a federally designated rural health clinic.


For years I worked hard and stayed at the office late and on weekends, being conscientious of providing the best quality care. I first became globally disillusioned with the trends in prescribing for chronic pain but I followed trends and guidelines. Then, guidelines and evidence regarding chronic disease management started shifting. I struggled to follow my interpretation of best evidence as guidelines diverged. Ultimately, as the sole shareholder of a tiny corporation with mounting debt, I found myself overwhelmed with the conflict between maintaining revenue by following pay for performance guidelines as the chasm between those guidelines and those of AAFP and USPSTF grew to the point of being irreconcilable.


Several years ago my wife told me that I could not change careers until my student loans were paid off. When my wife died I used the life insurance windfall to pay off my student loans and to take a year or more off work. I closed the business, as it was clear that revenues would never be adequate to pay the debt that my corporation owed.


At some point I’m going to have to work for a living. Six months have passed since I last collected a paycheck. Most days I find myself contemplating what kind of work I can do that will afford me income comparable to what I received at the pinnacle of my medical practice while doing anything other than medical practice, hopefully while continuing to adhere to my core values.